Pediatric anaphylaxis: age-related symptom trends and the limited role of allergen molecules: a retrospective analysis

Kucharek, I., Przystał-Dyszyński, K., Godyńska, A. et al. Allergy Asthma Clin Immunol (2025). https://doi.org/10.1186/s13223-025-01000-2

Abstract

Background

Emerging evidence suggests that specific allergen molecules may influence the clinical phenotype of anaphylaxis in children, but robust data are scarce. This study aimed to rigorously test the molecule-phenotype association in a large pediatric cohort and to determine the relative influence of the sensitizing molecule versus patient age on symptom presentation.

Methods

A retrospective analysis was conducted on 184 pediatric patients (0–18 years) hospitalized for anaphylaxis. Molecular allergen-specific immunoglobulin E (IgE) profiles were determined using the ALEX2 test. Symptom frequencies across different organ systems were analyzed in relation to allergen molecules and age groups using Cochran’s Q and Pearson’s χ2 tests.

Results

The most frequent molecular triggers were Ara h 2 (18.79%), Gal d 1 (9.09%), and Ana o 3 (9.09%). While significant differences in symptom distribution were observed within individual allergen molecules (p < 0.05), no molecule-specific symptom pattern was identified.

Trimethoprim-Sulfamethoxazole and Acute Respiratory Failure in Adolescents and Young Adults

Ahmadi F, McArthur E, Garcia-Bournissen F et al.  JAMA Netw Open. 2025;8(11):e2545251. doi:10.1001/jamanetworkopen.2025.45251

Key Points

Question  Is the use of trimethoprim-sulfamethoxazole (TMP-SMX) associated with an increased 30-day risk of hospital visits for acute respiratory failure among healthy adolescents and young adults compared with amoxicillin or cephalosporins?

Findings  In this cohort study of adolescents and young adults aged 10 to younger than 25 years in Ontario, Canada, initiation of TMP-SMX was associated with a significantly higher 30-day risk of a hospital visit for acute respiratory failure compared with amoxicillin and cephalosporins. The absolute risk increase was small (0.02%) but consistent across sensitivity analyses.

Meaning  These findings support the US Food and Drug Administration’s warning regarding the risk of acute respiratory failure with TMP-SMX in healthy adolescents and young adults, and clinicians and regulators should carefully weigh this risk when prescribing TMP-SMX and consider updates to prescribing guidelines and product labeling.

Abstract

Importance  The US Food and Drug Administration (FDA) has issued a warning and a label change regarding a potential association between trimethoprim-sulfamethoxazole (TMP-SMX) and acute respiratory failure in healthy adolescents and young adults.

Clinical outcomes after switching from omalizumab to anti-IL-5/IL-5R biologics in severe asthma: a retrospective cohort study

Akkuş, F.A., Çölkesen, F., Önalan, T. et al. BMC Pulm Med (2025). https://doi.org/10.1186/s12890-025-04044-7

Abstract

Background

Severe asthma (SA) is a heterogeneous disease composed of various clinical phenotypes, and criteria for selecting the most appropriate biological agent remain unclear. Therefore, when optimal control cannot be achieved with the initial biological therapy, switching between biological drugs is often performed.

Methods

This real-world study evaluated patients with severe asthma who initiated omalizumab treatment. Based on their treatment response, patients were divided into two groups: those who continued omalizumab and those who switched to mepolizumab or benralizumab. Clinical data were evaluated before biological treatment, after omalizumab therapy, and following the second biological therapy. Additionally, factors influencing the decision to switch and the effectiveness of the switch were analyzed.

Results

Of the total 51 patients, 45.1% (n = 23) switched to a second biological agent due to inadequate response to the initial treatment.

Comparative efficacy and safety of biologics and systemic immunomodulatory treatments for chronic urticaria: Systematic review and network meta-analysis

Chu AWL, Oykhman P, Chu X et al.  J Allergy Clin Immunol. 2025 Oct;156(4):1008-1023. doi: 10.1016/j.jaci.2025.06.004.

Abstract

Background

Chronic urticaria is a common skin condition characterized by itchy wheals (hives), angioedema, or both, lasting for 6 weeks or more. Beyond antihistamines, multiple systemic treatments are available, but there is uncertainty regarding their comparative effects on chronic urticaria outcomes.

Objective

We systematically synthesized the comparative benefits and harms of systemic treatments for chronic urticaria.

Methods

As part of updating the AAAAI/ACAAI JTFPP chronic urticaria guidelines, we searched Medline, Embase, Central, Chinese Biomedical Databases (CBM), China National Knowledge Infrastructure (CNKI), Chinese Scientific Journal Database (VIP), and Wanfang from inception to February 4, 2025, for randomized trials addressing systemic immunomodulatory treatments, including phototherapy, for chronic urticaria.

Association between eye washing and ocular symptoms of hay fever: a mobile app-based prospective cohort study in Japan

Nagino, K., Sung, J., Midorikawa-Inomata, A. et al.  Sci Rep 15, 41048 (2025). https://doi.org/10.1038/s41598-025-24950-4

Abstract

Large-scale analyses of the relationship between eyewash and hay fever symptoms after adjusting for factors associated with allergic symptoms have not yet been conducted. We aimed to evaluate the association between eyewash and ocular symptoms of hay fever. In this digital prospective observational cohort study, we used the AllerSearch smartphone application. Participants reported symptoms (eye itching, tearing, and redness) and their preventive behaviors such as eye washing. Multivariate regression analysis was used to determine the association; temporal changes in ocular symptoms were compared using a mixed-effects model.

Temporal changes in the estimated symptom scores for
the eyewash and non-eyewash groups

Of 476 included participants, 71 practiced eye washing.

Endotypes of atopic dermatitis

Fyhrquist N, Yang Y, Karisola P, Alenius H. J Allergy Clin Immunol. 2025 Jul;156(1):24-40.e4. doi: 10.1016/j.jaci.2025.02.029.

Abstract

 Pathogenetic pathways, immune endotypes,
and targeted treatments in AD.

Atopic dermatitis (AD) is a chronic, heterogeneous skin condition driven by a combination of genetic, immune, and environmental factors. The original classification into extrinsic and intrinsic endotypes has proven to be too simplistic. Recent research into the varied immune profiles and molecular signatures of AD has revealed distinct endotypes—that is, subtypes defined by specific biological processes rather than visible symptoms alone. These endotypes encompass classifications that are based on immune pathways, including TH2 dominant, TH1, TH17/TH22-driven responses, genetic factors, and microbial interactions.

Diagnosis and management of mast cell activation syndrome (MCAS) in Canada: a practical approach.

Lee, E., Picard, M. Allergy Asthma Clin Immunol 21, 49 (2025). https://doi.org/10.1186/s13223-025-00998-9

Abstract

Stepwise practical approach to diagnose and treat MCAS

An increasing number of patients are presenting to allergists with concerns about mast cell activation syndrome (MCAS), often in the context of persistent, unexplained, multisystem symptoms. This review aims provide a practical, stepwise approach to the diagnosis and management of MCAS, based on the consensus criteria established by the European Competence Network on Mastocytosis—American Initiative on Mast Cell Diseases, an international consortium of leading experts in mast cell disorders endorsed by major scientific organizations. The first step is to evaluate whether the clinical presentation is consistent with MCAS, recognizing that the prototypical presentation is idiopathic anaphylaxis. Symptoms should be severe, episodic, typical of mast cell activation, and involve at least two organ systems. The next step is to exclude secondary causes of mast cell activation, particularly cofactor-dependent food allergy and nonsteroidal anti-inflammatory drug hypersensitivity.

Azelastine Nasal Spray for Prevention of SARS-CoV-2 Infections: A Phase 2 Randomized Clinical Trial.

Lehr T, Meiser P, Selzer D et al. JAMA Intern Med. 2025 Nov 1;185(11):1309-1317. doi: 10.1001/jamainternmed.2025.4283. Erratum in: JAMA Intern Med. 2025 Nov 1;185(11):1401. doi: 10.1001/jamainternmed.2025.5850.

Key Points

Question  Is regular application of azelastine nasal spray associated with reduced risk of SARS-CoV-2 infections?

Findings  In this randomized placebo-controlled clinical trial that included 450 participants, the incidence of laboratory-confirmed SARS-CoV-2 infections was significantly lower with application of azelastine nasal spray compared with placebo treatment.

Meaning  The use of azelastine nasal spray may help to reduce the risk of SARS-CoV-2 infections.

Abstract

Importance  Limited pharmaceutical options exist for preexposure prophylaxis of COVID-19 beyond vaccination. Azelastine, an antihistamine nasal spray used for decades to treat allergic rhinitis, has in vitro antiviral activity against respiratory viruses, including SARS-CoV-2.